Mushroom toxicity Flashcards
Toxicity by class
Cyclopeptide
Contain amatoxins (highly toxic) and phallotoxins (medium toxicity).
o Target organ: Liver, due to impaired protein synthesis, possibly renal injury.
o Time course of poisoning:
6-12 hrs - GI upset, diarrhea, abdominal cramping.
12-24 hrs - Resolution of GI symptoms but hepatic enzymes begin to rise.
24-72 hrs - Hepatic and renal failure, encephalopathy, with 10-30% fatality rate.
o Treatment: Consider MDAC; early initiation of investigational antidote, silymarin derived from milk thistle
(Legalon SIL); last resort is liver transplant.
Gyrometrin
o Toxin is methyl-hydrazine which causes hepatocellular damage and seizures similar to isoniazid.
o Symptom onset 6-12 hrs: GI upset, dizziness, headache; severe poisoning (jaundice and seizures).
Methemoglobin, hemolysis, and renal failure are also possible.
o Treatment: Antidote pyridoxine (Vitamin B6) to aid GABA synthesis, along with benzodiazepines.
o Toxicity can be prevented by cooking/boiling but fumes inhaled during cooking are toxic.
Muscarine
o C. gentilis species is most common in US; most poisonings are in Europe.
o GI upset within 24-36 hrs.
o Acute renal failure with oliguria, 3 days to 3 weeks after ingestion due to injury to renal tubules. The
shorter the time to onset of sx, the more severe the renal injury.
Muscarine
o Cholinergic muscarinic receptor agonist with no CNS activity.
o SLUDGE syndrome in 30 minutes to 3 hrs.
o Treatment: Atropine.
Coprine
o Symptoms occur ONLY if ethanol is also taken within 48-72 hours after eating mushroom.
o Coprine inhibits the enzyme that finishes alcohol metabolism and acetaldehyde accumulates, causing a
“disulfiram-like” reaction within 30 minutes to 3 hrs after ethanol.
o Flushing, vomiting, and possible hypotension.
Ibotenic acid and Muscimol
Red caps with white warts.
o Potent selective agonist of GABA subreceptor that induces delirium.
o Also significant amounts of anticholinergic agents and small amounts of muscarine.
o Within 3 hours: Delirium, confusion, hyperactivity, tremors, convulsions.
o In 10-15 hours: Exhaustion, coma.
o Treatment: Supportive care – NO atropine, NO physostigmine; they are not effective to reverse coma.
Psilocybin
o Serotonergic psychedelic. Caution: “Street” mushrooms may be spiked with LSD.
o In 30 minutes to 2 hours: Possible GI upset, vomiting, euphoria, hallucinations (vivid geometrics like the
Southwest Indian blankets), hyperthermia, rare convulsions.
o Mydriasis is characteristic, 90% incidence.
o Treatment: Benzodiazepines.
GI toxins
o In 30 minutes to 3 hours onset of vomiting, diarrhea, abdominal pain.
o Early onset of GI symptoms is key to identification.
Alenic Norleucine-
o May be mistaken for Matsutake (a highly desirable edible with spicy aroma and flavor).
o Early GI symptoms followed by acute renal failure in 4-6 days.
o Weeks of hemodialysis may be needed.
Lycoperdon-associated pneumonitis
Some Puffball mushroom species cause pulmonary immune-mediated reaction to inhaled spores.
